Healthcare Provider Details

I. General information

NPI: 1659166650
Provider Name (Legal Business Name): CRISTAL RODRIGUEZ BELTRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 ROCKLIN RD APT 903
ROCKLIN CA
95677-3520
US

IV. Provider business mailing address

101 CIRBY HILLS DR
ROSEVILLE CA
95678-4360
US

V. Phone/Fax

Practice location:
  • Phone: 951-809-1929
  • Fax:
Mailing address:
  • Phone: 916-787-8860
  • Fax: 916-787-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: